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Congenital
Congenital Defects
| Question | Answer |
|---|---|
| FWS or FUO? Get baseline labs | FUO - shotgun approach |
| "FWS or FUO? No baseline labs, except an occasional UA" | FWS |
| FWS or FUO? Admission is like3ly and needed | FUO |
| FWS or FUO? No empiric antibiotics | Both FWS and FUO. Exception is if a kid looks sick and has FUO |
| FWS or FUO? Empiric antipyretics | FWS |
| "The Sepsis Infection Response Syndrome (SIRS) is better 4 dxing adults than peds, so I will not write questions about them" | FYI |
| SIRS due to infection is called | sepsis |
| SIRS with one or more end organs compromised is called | severe sepsis |
| Severe infection resulting in systemic hypOtension is called | septic shock |
| Most common cause of sepsis in neonates | Group B Strep |
| 3 most common causes of sepsis in neonates | "Group B Strep, E. Coli, Listeria" |
| Most common causes of sepsis in infants and toddlers is… | Pneumococcus. H. flu. and gram neg rods like E Coli |
| How do you dx sepsis? | clinically. Child will appear toxic |
| "What major systems are affected in a ""toxic"" child?" | "CNS, CV, Resp, Renal (or anything that indicates END ORGAN DAMAGE)" |
| What CNS signs indicate that a child is toxic? | "Abnml alertness, poor eye contact, inconsolable crying" |
| What CV signs indicate that a child is toxic? | "Tachycardia, hypotension, poor capillary refill, cyanosis" |
| What respiratory signs indicate that a child is toxic? | hyperventilation leading to hypoventilation |
| What renal signs indicate that a child is toxic? | poor urine output |
| "If a neonate or infant <3mos has left the hospital and appears septic, what labs should you draw to evaluate?" | "CBC, BC x 2, UA & UC, chem7 in all patients. LP is suspected meningitis. CXR if aqbnl lung exam" |
| Treatment for sepsis requires hospitalization for close monitoring and early aggressive IV abx use to tx the cause. What abx should you use in neonates? Children? | NEONATES: Amp/Gen. Children: Cefoxitin or Rocephin |
| What are the MC causes of septic meningitis in neonates? (clue: it's the same as sepsis) | "GBS, E. coli, Listeria " |
| What are the MC causes of septic meningitis in infants? (clue: two are the same as sepsis +1) | "H. Flu, Pneumococcus, N. meningitidis" |
| What organism is known to cause septic meningitis in neonates and teens? | Chlamydia trachomatous |
| What are the MC causes of aseptic meningitis? | "Viruses (ie Enterovirus, HSV, and arbovirus (rare)" |
| "Other than viruses, what else can cause aseptic meningitis in children?" | "Fungal, parasitic, and TB" |
| It's very rare to have meningitis without (write in)… | fever |
| What are common S&S of meningitis? | "fever, AMS, HA, neck pn, progressive onset" |
| What might you find on exam of a child with meningitis? (Funky BB PP -- FTNK BB PP) | "fever, toxic apperance, nuchal rigidity (not common in under 2yo), kernig's sign, brudzinski's sign, bulging fontanelles, petichiae or purpura" |
| Which organism can cause septic meningitis that can take a child from slightly ill to dead in hours? | N. meningitidis |
| Which type of meningitis can cause purpura and may cause death even after treatment? (write in) | meningococcal meningitis |
| What lab values are consistent with meningitis? | "Leukocytosis with neutrophilia on CBC, LP with an opening pressure >20 cm H20" |
| What should you do before a lumbar puncture (especially if noted papilledema or focal neurological signs)? | CT |
| "WBC/cc of 1-50,000 indicate what type of infection?" | bacterial |
| "WBC/cc of <1,000 indicate what type of infection?" | viral |
| WBC/cc of <500 indicate what type of infection? | TB |
| "If the lab comes back with a positive gram stain or culture, what type of organism is likely to cause the infection?" | bacterial |
| "What pathology presents like meningitis, but often has focal deficits, seizures and mental status changes?" | encephalitis |
| "What pathology presents like meningitis, but often has focal deficits, and can only be diagnosed on CT?" | CNS abscess |
| What abx do you use to treat meningitis in neonates? In infants/children? | NEONATES: Amp/Gen. Children: High Dose Rocephin |
| What general tx methods should you use to treat meningitis? | "Aggressive abx, Hospitalization (possibly ICU), IV hydration and antipyretics" |
| How can you prevent meningitis for those who are NOT close contacts? What about those who are? | Meningococcal vaccine for all children at 11-12 yo and all adolescents going to military or dorm // CLOSE CONTACTS: Rifampin for 2 days |
| What type of organisms most commonly cause encephalitis? | "viruses (ie Enterovirus, HSV, and arbovirus" |
| This type of encephalitis presents similar to multiple sclerosis | "Acute disseminated, encephalomyelitis (ADEM)" |
| What do you need for a definitive dx of encephalitis? | EEG or neuroimaging |
| ADEM usu responds to… | steroid |
| HSV encephalitis usually resolves with | acyclovir |
| What are the two main types of bacteremia? | "source (eg pneumonia, cellilitis, etc) and occult (hidden causes ie UTIs)" |
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